骨水泥注射量及弥散程度与PVP治疗OVCF的疗效分析  

Correlation analysis of bone cement volume and dispersion and the clinical efficacy of PVP for OVCF

作　　者：冯献礼 高彤 张喜善 Feng Xianli;Gao Tong;Zhang Xishan(Department of Spine,The Second Affiliated Hospital of Shandong First Medical University,Taian 271000,China;Shandong Second Rehabilitation Hospital,Taian 271000,China)

机构地区：[1]山东第一医科大学第二附属医院脊柱科,泰安271000 [2]山东省第二康复医院,泰安271000

出　　处：《中华老年骨科与康复电子杂志》2024年第4期193-201,共9页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：山东第一医科大学学术提升计划(2019QL017)。

摘　　要：目的回顾性分析骨水泥注射量及弥散情况与经皮穿刺椎体成形术(PVP)治疗骨质疏松性椎体压缩性骨折(OVCF)疗效的相关性,为临床医师提供一定参考。方法纳入2018年3月至2020年9月就诊于山东第一医科大学第二附属医院确诊为骨质疏松椎体压缩性骨折并行单椎体PVP手术治疗的患者。收集患者年龄、性别、骨折节段、伤椎椎体压缩程度、术前术后视觉模拟评分法(VAS)、腰痛ODI评分、骨水泥渗漏情况、骨水泥注射量以及弥散分布等信息,按照骨水泥注射量以及弥散分布情况分组,统计分析骨水泥渗漏率、临床疗效改善程度、伤椎高度恢复情况等。结果本研究一共纳入111名患者,伤椎数量111个。男性患者34例,女性患者77例。平均年龄(70.23±4.76)岁。所有患者术后腰背部疼痛均明显缓解,不同骨水泥注射量和弥散程度组间各时间节点的VAS与ODI评分差异无统计学意义。所有伤椎发生椎体渗漏率为17.17%,随着骨水泥注射量升高,骨水泥渗漏发生率逐渐升高(P=0.019),骨水泥弥散程度越高,骨水泥渗透发生率越高(P<0.001)。所有患者术后伤椎高度平均恢复比例为(14.97±9.26)%。高剂量组恢复比例最大[(17.08±13.50)%],差异具有统计学意义(P=0.048);弥散程度Ⅲ级的伤椎恢复比例最大[(19.32±9.48)%],差异有统计学意义(P=0.037)。所有患者邻椎骨折发生率为9.91%,其中骨水泥注射量与骨水泥弥散程度越高,邻椎骨折发生率随之增高(P=0.010,P=0.035)。随访期间未发生骨水泥过敏、骨水泥栓塞等并发症。结论PVP可有效缓解OVCF患者的术前症状,改善生活质量。症状改善与骨水泥注射量和弥散程度无明显相关性。骨水泥注射量的升高以及骨水泥弥散程度增高可以提高伤椎高度恢复比例,但同时也提高骨水泥渗漏发生率和邻椎骨折发生率。当使用中等剂量骨水泥(4~6mL)以及骨水泥弥散程度为Ⅱ级时,在有效�Objective To retrospectively analyze the correlation between the bone cement volume and dispersion and the efficacy of PVP in the treatment of osteoporotic vertebral compression fracture(OVCF),so as to provide some reference for surgeons.Methods Patients who were diagnosed with OVCF and underwent single vertebral PVP surgery in the Second Affiliated Hospital of Shandong First Medical Uni-versity from March 2018 to September 2020 were included.Information such as age,gender,fracture seg-ment,degree of vertebral compression of injured vertebrae,VAS score and ODI score before and after sur-gery,bone cement leakage,bone cement volume and distribution were collected.The bone cement leakage rate,the improvement of clinical efficacy,and the recovery of injured vertebral height were statistically ana-lyzed according to bone cement volume and distribution.Results A total of 111 patients were included in this study,with 111 injured vertebrae.The low back pain of all the patients in the different groups was signifi-cantly relieved,and the VAS and ODI scores at each time point had no significant correlation with the vol-ume and dispersion degree of bone cement.The incidence of vertebral body leakage in all injured vertebrae was 16.96%.With the increase of bone cement volume,the incidence of bone cement leakage gradually in-creased(P=0.019).The higher of the dispersion degree of bone cement,the incidence of bone cement pene-tration increased(P<0.001).The average recovery rate of injured vertebral height in all patients was(14.97±9.26)%.The recovery rate in the high-dose group was the largest(17.08±13.50)%,with a statistical differ-ence(P=0.048).The proportion of recovery was the largest(19.32±9.48)%in the injured vertebra of diffu-sion gradeⅢ(P=0.037).The incidence of adjacent vertebral fractures in all patients was 9.91%.The higher volume and dispersion degree of bone cement,the higher the incidence of adjacent vertebral fractures(P=0.010,P=0.035).No complications such as bone cement allergy and bone cement embolism occ

关 键 词：骨质疏松椎体压缩骨折 经皮穿刺椎体成形术 骨水泥 弥散程度 渗漏 

分 类 号：R687.3[医药卫生—骨科学]